Getting Ready for Transplant - Research, Thoughts, Opinions?

[g4designs]

This year I decided I am going to fully commit to a hair transplant. I've been on Finasteride for about 5 months now and 5% Minoxidil for a little over a year (previously on a Min/Fin compound). I'm in my mid-20s and have already met with a dermatologist and a local hair surgeon, both of whom have said I've been a good candidate for a while. I have a bunch of questions and I'd really appreciate any help you guys could provide. I'm not new to this journey, I've been fighting this since I was 18.

I attached some photos of where I'm at. I believe I'm a Norwood 3A. Does that sound right?

I'm willing to spend a decent chunk to fix this for good. I've already talked with my friends and family and they are very uncomfortable with me going to Turkey (which I respect), but I wouldn't mind traveling anywhere in North America (US or CAN) to get good results for a reasonable price. Ideally, I'm looking to spend $12,000 or less. I'm a young adult and would likely be taking a hefty loan from family for what I cant cover in cash, but this is important enough for me to justify it. Since Turkey is out of the picture, is this a reasonable budget for the amount of follicles I'd need? I would much rather get FUE than FUT, but I'd also be open to new technologies if there are other options. My dermatologist and the my local surgeon both said I have a good sized donor area on the back of my head and I have plenty of facial and upper body hair as well. I attached a photo of what I believe would be my donor area - it is very thick.

It seems what everyone suggests is to look at past results and find a doctor who is experienced with my hair type and Norwood stage. In my area (GA), I've seen good results from Cooley Hair Center (NC) and Dr. Rousso (AL). I've already met with Doctor Anderson in Atlanta, but he left a pretty rude first impression. He came off pretty condescending when I asked more about the scientific validity of the $1200 laser cap he was trying to sell me. Looking back, it could have just been that he though I was 'some kid' wasting his time and not a real client. Overall, I'm looking for a surgeon or a team who is willing to take care of me. I'm looking for someone who is willing to do whatever it takes to get me the best results -- someone that sees FUE almost as an artform, rather than just rushing to get me out so he can fit in his 3-o-clock appointment before a round of golf.

Are there any special or new technologies or techniques I should look out for? I've seen ARTAS iX and NeoGraft mentioned. Are there any other new technologies? I'd also consider getting SMP tattoos, if necessary. 

To put it simply, I'm looking to take back control of how I look. I'm sick of wearing hats because I don't like who I see in the mirror. I would like to bring my temples back to a reasonable level. I naturally had a high widow's peak, and hair loss brought it even farther back. The last photo attached is my goal. Is this unrealistic in my budget? Do I need to start shaking trees?

I've seen several places warning to turn around and walk out of anywhere charging per follicle. That being said, I don't have money to burn. I'm ready to commit to a hefty price-tag, but I need every dollar to count. Am I insane? Or is it possible clinics would be reasonable with pricing for a young-adult willing to spend a decent chunk of his life savings to regain control and confidence?

Finally, is now the right time for this? Or am I going to spend $15k only to see "magic pill finally approved by FDA" the next day? Has there been any progress on "the cure" that's been "5 years away" for the past 30+ years? Is there any promising science in the pipeline or delayed due to COVID that'll show up? 

I've done a fair bit of research so far, but any more help, thoughts, or opinions would be great. Thank you!

[Curious25]

Wow , how did you manage to draw up your goal ‘after picture’ ? It looks like a legitimate before and after from a top clinic ! 😂 

[Curious25]

In answer to your post - I’ve only skim read through it, but my take aways are; 

 

-you have a decent dense looking donor, 

-there’s going to be no magic pill to reverse your loss coming out for a long time, if ever 

-your age may present as a limitation. The fact you’re committed to medication will help ease that limitation. 
 

-$12,000USD isn’t going to be enough for you to achieve your desired result in any top clinic in the US - possibly in Europe, depending on your graft quotations - if you just address the frontal loss and leave the crown, I think you’d be looking at minimum 3000 grafts - which as far as Im aware, the lower priced end of the worlds best clinics are still looking for €4 per graft, so if you do the maths . . 

[Gatsby]

In short, forget Turkey and research. Put price last and quality that matches your hair loss characteristics for now and the future first. The hairline you have designed in twenty years from now is not an age appropriate one (for you to grow into). If you find the surgeon that ticks all of your boxes for the right reasons then you are better off to spend your time researching saving up for the right game plan for you over the lifespan. All the best!

[ITA]

@g4designsI disagree with @Gatsby this time,(I usually agree with him, most of the time). in Turkey it is enough not to rely on the low-cost clinics or pseudo-clinics of which Istanbul is full, but not eliminated a priori.  In my opinion, the only clinics to consider in that place are HLC and Pekiner, forget the “all inclusive clinics”.

[Gatsby]

2 minutes ago, Egy said:

@g4designsI disagree with @Gatsby this time,(I usually agree with him, most of the time). in Turkey it is enough not to rely on the low-cost clinics or pseudo-clinics of which Istanbul is full, but not eliminated a priori.  In my opinion, the only clinics to consider in that place are HLC and Pekiner, forget the “all inclusive clinics”.

I agree Egy. My point is not to get carried away with cost first (as Turkey has some of the cheapest options) but to focus on the quality of work and to find this out by research. If this happens to be a surgeon in Turkey then all the better. But this will only come from research. Not putting cost before results. 👍

[BLE123]

I also don't think Turkey should be discounted. Writing off an entire country and many good surgeons because there's also a bunch of cheap shady clinics isn't fair. Of course if you go to a clinic offering a hair transplant for the price of a bag of skittles then you're very likely not going to get a great result but this is surely just common sense. You have to realise though that the average income in Turkey is very low compared to the US or other countries so they can't charge the same prices, this goes for the best clinics too who are charging €2.5-€3 per graft but that's the equivalent of paying like €10/graft in the US.

[nicoandgello]

1 hour ago, Gatsby said:

The hairline you have designed in twenty years from now is not an age appropriate one (for you to grow into).

What? That looks like normal hairline. Its matured, looks manly, has proportional height, frames his face well and has nice NW1.5 recession. HT is a cosmetic surgery that can improve your live. Would you say that someone that is in great shape, trains 4 times a week should become an overweight ugly dude, so he can look like everybody else, and fit in?

[Curious25]

1 hour ago, Gatsby said:

In short, forget Turkey and research. Put price last and quality that matches your hair loss characteristics for now and the future first. The hairline you have designed in twenty years from now is not an age appropriate one (for you to grow into). If you find the surgeon that ticks all of your boxes for the right reasons then you are better off to spend your time researching saving up for the right game plan for you over the lifespan. All the best!

Totally disagree with all of this. 
 

1) To disregard a whole nation based on the fact that there are cheap black market ‘hair mill’ clinics there, (as there are in every country), is short sighted and just frankly moronic. The competitive prices from these clinics aren’t down to the fact that they fall into the hair mill category, it’s a macro economic factor based upon comparative currency values, cost of living, average wages, rent, materials etc. I’m not suggesting the following surgeons are or aren’t suitable for OP’s case, but are you telling me HLC, Dr Bicer, Dr Kaan, and Dr Keser haven’t produced world class results on this forum over the years ? 
 

2) The hairline design that OP managed to somehow recreate in the photo on the right hand side is nothing short of artistic perfection. It is appropriately dense, frames the forehead and face perfectly, presents subtle a-symmetry, and facilitates age appropriate temple maturation, whilst still maintaining a youthful and healthy appearance. This is exactly what all frontal hairline restoration procedures should strive to achieve, an equilibrium between objectively enhancing ones front on profile, whilst not appearing unnatural or forced. 
 

 

Edited March 9, 2021 by Curious25

[Curious25]

1 hour ago, Gatsby said:

I agree Egy. My point is not to get carried away with cost first (as Turkey has some of the cheapest options) but to focus on the quality of work and to find this out by research. If this happens to be a surgeon in Turkey then all the better. But this will only come from research. Not putting cost before results. 👍

That wasn’t your point though was it, because ‘in short’ you told OP to forget Turkey altogether. 

[deeznuts]

 

3 hours ago, Curious25 said:

Wow , how did you manage to draw up your goal ‘after picture’ ? It looks like a legitimate before and after from a top clinic ! 😂 

I think he photoshopped Rick Astley's hair onto his head. The real question though is if he's ever gonna give you up or let you down

Also, +1 for Europe. Europe would be my second choice after Canada since I'm Canadian and we got H&W in our backyard somewhere about 3000 km to the west lol. Europe has such a great combination of affordability and great surgeons. The only thing holding me back from going to De Freitas is the fact that he's in Europe and he doesn't have the amount of patient posted results that a clinic like H&W has. 

[Gatsby]

21 minutes ago, Curious25 said:

That wasn’t your point though was it, because ‘in short’ you told OP to forget Turkey altogether. 

"I'm looking to spend $12,000 or less. I'm a young adult and would likely be taking a hefty loan from family for what I cant cover in cash, but this is important enough for me to justify it."

Yes. BASED ON PRICE! Research comes first. I would hate to see this person coming back to the forum in 6 months stating I went to X,Y,Z surgeon in Turkey and I wish I never had 'surgery.' Choosing a surgeon doesn't come sown to nationality. It comes down to choosing the right surgeon with a consistent body of work that yields natural results. Then that surgeon has to be suited to the individual patient's hair loss needs over the life span. So am I anti Turkey when a young guy posts that he is looking for surgery based on a budget? No. I'm anti cheap budget shopping first and foremost and pro research. India is no different. But on an almost f/nightly basis someone posts that they have been to Turkey and they feel that they were butchered. It's almost as bad as Australia. As an Ozzie I always say do not get a hair transplant here in Australia. Does anyone ever call me out for being un Australian??? If you are willing to risk having an ex barber, hair dresser, taxi driver or Syrian refugee perform surgery on you then be my guest. I just don't want people to make the same mistakes that others have including myself.

[Gatsby]

1 hour ago, BLE123 said:

I also don't think Turkey should be discounted. Writing off an entire country and many good surgeons because there's also a bunch of cheap shady clinics isn't fair. Of course if you go to a clinic offering a hair transplant for the price of a bag of skittles then you're very likely not going to get a great result but this is surely just common sense. You have to realise though that the average income in Turkey is very low compared to the US or other countries so they can't charge the same prices, this goes for the best clinics too who are charging €2.5-€3 per graft but that's the equivalent of paying like €10/graft in the US.

It's not about the average income. I've lived in Turkey for 6 months. It's about being able to do up to ten patients a day that brings the price down and what they pay the techs to do. Don't take my advice. Go there and research this.

[Gatsby]

47 minutes ago, nicoandgello said:

What? That looks like normal hairline. Its matured, looks manly, has proportional height, frames his face well and has nice NW1.5 recession. HT is a cosmetic surgery that can improve your live. Would you say that someone that is in great shape, trains 4 times a week should become an overweight ugly dude, so he can look like everybody else, and fit in?

It looks not only like a normal hairline. It looks like a great hairline for his age. How will that hairline look in 30 years? Could those grafts have been better utilized in other areas? Has anyone thought of using augmented beard grafts as well? You've lost me in your overweight, ugly dude analogy???

[BLE123]

25 minutes ago, Gatsby said:

It's not about the average income. I've lived in Turkey for 6 months. It's about being able to do up to ten patients a day that brings the price down and what they pay the techs to do. Don't take my advice. Go there and research this.

Again though you're talking about hair mills, you can't throw them all under the same blanket. 

There are highly competent surgeons doing one patient/1000 grafts per day procedures and putting out results that rival far more expensive clinics. It also absolutely is about average income, if the crap clinics priced themselves at the same price as a crap US clinic and the top ones priced themselves as the top US clinics then no one is going to be able to afford them, certainly not the locals and the foreigners would have no reason to go there. 

I guess I just don't understand the mentality that an entire country should be avoided because there are a load of shoddy clinics. That would be true if you were picking a name out of a hat but thanks to forums like this we know quite well those who are doing good consistent work and those that should be avoided.

[nicoandgello]

59 minutes ago, Gatsby said:

It looks not only like a normal hairline. It looks like a great hairline for his age. How will that hairline look in 30 years? Could those grafts have been better utilized in other areas? Has anyone thought of using augmented beard grafts as well? You've lost me in your overweight, ugly dude analogy???

It will look absolutely normal. Its normal "matured" hairline of a lucky guy. Nothing unrealistic about it. It will look great both at 26 and 78. He said that he is using meds, so the chance of him being more than NW4 in his lifetime is low.

[nicoandgello]

27 minutes ago, BLE123 said:

Again though you're talking about hair mills, you can't throw them all under the same blanket. 

There are highly competent surgeons doing one patient/1000 grafts per day procedures and putting out results that rival far more expensive clinics. It also absolutely is about average income, if the crap clinics priced themselves at the same price as a crap US clinic and the top ones priced themselves as the top US clinics then no one is going to be able to afford them, certainly not the locals and the foreigners would have no reason to go there. 

I guess I just don't understand the mentality that an entire country should be avoided because there are a load of shoddy clinics. That would be true if you were picking a name out of a hat but thanks to forums like this we know quite well those who are doing good consistent work and those that should be avoided.

Our world today has gone mad. Turkey has very quality clinics for good value. Most people cant afford housing, essential drugs and surgery for their QOL improvement, and people on this forum are still acting like "money shouldnt matter". What a joke.

[Raphael84]

@g4designs

Do you feel that your hair loss has stabilised with medication? You are still reasonably early in your "finasteride journey".

In a case such as yours, as a younger patient in your mid 20s, one important consideration will be progressive loss. As you have loss both in your frontal area, and a thinning crown, the concern is that over time as loss evolves, your crown loss will meet your frontal loss. In your photos, if you look at hair quality in your donor area, and compare that to the hair quality on top, your hair on top appears weaker and finer. Im not referring to density, but the quality of your hair.  In your mid 20s, if hair loss began at 18, you may have been experiencing loss for 7/8 years. Hair loss being progressive in nature, will continue past middle age, and so there is 35+ years ahead to consider and be conscious of.
How you may respond to medication will be an important factor in your long terms objectives.

When designing the hairline, if the design is aesthetically pleasing is only one factor. Based on the photo and design that you have digitally edited, 3000 grafts would approximately restore your frontal third. Can your donor support further loss and provide a full restoration over subsequent surgeries as you age? This will depend on your donor density, follicular groupings and hair calibre, which also must have an influence on the most appropriate hairline design for you. No specific data is known and so all opinions currently are subjective

Whatever your decision may be, your choice in potential doctor must have your long term objectives as their priority, and plan any frontal restoration accordingly with a very specific and bespoke approach. You will lose more hair, and whilst there is no crystal ball regarding extent and rate of future loss, this must be taken into consideration and will be integral to your long term satisfaction. Whilst now your hairline is your priority, and quite rightly. You likely will not be satisfied in 10 years time with a great hairline but a larger balding crown. This is something that younger patients are often not able to relate to, and believe that as they hit their late 30´s, it really won't matter any more. In reality, that is rarely the case.

7 hours ago, g4designs said:

The last photo attached is my goal. Is this unrealistic in my budget?

The question really isn't if it is realistic in your budget, but if it is realistic in terms of what your donor can provide and if it is the optimal approach when considering progressive loss as a patient in their mid-twenties.

I wish you the best of luck in your further research.

[g4designs]

Oh, wow! This is a lot of information to take in. Thank you everyone who has taken the time to reply so far. I'll try to address and answer everything.

7 hours ago, Curious25 said:

Wow , how did you manage to draw up your goal ‘after picture’ ? It looks like a legitimate before and after from a top clinic ! 😂 

@Curious25 Haha -- I found a local clinic (Cooley Hair Center) with a patient I feel I'm very similar to. I just worked a little magic on the color and blending, then shaped it to match my natural peak.

 

6 hours ago, Gatsby said:

In short, forget Turkey and research. Put price last and quality that matches your hair loss characteristics for now and the future first. The hairline you have designed in twenty years from now is not an age appropriate one (for you to grow into). If you find the surgeon that ticks all of your boxes for the right reasons then you are better off to spend your time researching saving up for the right game plan for you over the lifespan. All the best!

6 hours ago, Egy said:

@g4designsI disagree with @Gatsby this time,(I usually agree with him, most of the time). in Turkey it is enough not to rely on the low-cost clinics or pseudo-clinics of which Istanbul is full, but not eliminated a priori.  In my opinion, the only clinics to consider in that place are HLC and Pekiner, forget the “all inclusive clinics”.

@Gatsby @Egy I appreciate the replies. Thus far, I've been avoiding the idea of going to Turkey (as appealing as it seems) because my friends and family are very uncomfortable with the idea of me going overseas for a surgery. Godforbid, if something were to go wrong, someone would have to book a last minute 14hr flight to come help me. The two main concerns I've heard are Turkey's proximity to the middle east (and civil unrest) and the lack of accountability. If I come back to the states and it turns out to be an absolute butcher job -- there's a lot less I can do than if it were in the states. 

It also really bothers me that there are so many sketchy users (with auto-generated names) on other forums and the HairTransplant subreddit constantly singing the praise of Turkey and India. It really seems like astroturf marketing. (not like people in this thread who are sharing actual opinions, its more the "I just had it done in Turkey, message me and I'll share the info" posts)

 

6 hours ago, Gatsby said:

I agree Egy. My point is not to get carried away with cost first (as Turkey has some of the cheapest options) but to focus on the quality of work and to find this out by research. If this happens to be a surgeon in Turkey then all the better. But this will only come from research. Not putting cost before results. 👍

I completely agree with this sentiment. When all is said and done, I'm looking to invest in my future. Whether that costs $7k, $12k, or $20k doesn't matter as long as I get results I am happy with. Do you have any recommendations for how to research based on the quality of work? I've been trying, but it doesn't help every clinic only posts their world-class results online. 

 

5 hours ago, Curious25 said:

Totally disagree with all of this. 
 

1) To disregard a whole nation based on the fact that there are cheap black market ‘hair mill’ clinics there, (as there are in every country), is short sighted and just frankly moronic. The competitive prices from these clinics aren’t down to the fact that they fall into the hair mill category, it’s a macro economic factor based upon comparative currency values, cost of living, average wages, rent, materials etc. I’m not suggesting the following surgeons are or aren’t suitable for OP’s case, but are you telling me HLC, Dr Bicer, Dr Kaan, and Dr Keser haven’t produced world class results on this forum over the years ? 

If I am able to convince the people in my support network to consider Turkey as a viable option, how do I approach this safely? I know nothing about the country and culture besides the fact that there aren't a ton of regulations and it is a leading health-tourism spot. What precautions and safety-nets are in place? How do I make sure I don't get screwed over? Is it a safe place to be? Are there any reputable services in the area that will help guide dumb foreigners through the process? The idea of being drugged-up on pain meds on the other side of the world sets off some red flags.

 

57 minutes ago, Raphael84 said:

@g4designs

Do you feel that your hair loss has stabilised with medication? You are still reasonably early in your "finasteride journey".

In a case such as yours, as a younger patient in your mid 20s, one important consideration will be progressive loss. As you have loss both in your frontal area, and a thinning crown, the concern is that over time as loss evolves, your crown loss will meet your frontal loss. In your photos, if you look at hair quality in your donor area, and compare that to the hair quality on top, your hair on top appears weaker and finer. Im not referring to density, but the quality of your hair.  In your mid 20s, if hair loss began at 18, you may have been experiencing loss for 7/8 years. Hair loss being progressive in nature, will continue past middle age, and so there is 35+ years ahead to consider and be conscious of.
How you may respond to medication will be an important factor in your long terms objectives.

@Raphael84 In the first few months, I've noticed a few week-long cycles of increased and decreased shedding, which I've heard is normal. I noticed my crown and center forehead thinning in the last year (especially with a shorter haircut), so it will be interesting to see if this continues or plateaus. 

I've had a fair amount of people suggest I continue on the finasteride and topical 5% minoxidil, then start using my Derminator 2 (which I bought, but have been afraid to try) for at least another 6 months. I'm starting to think this might be the right call. I'll schedule a consultation with some of my local doctors to get a few different opinions. 

In the meantime, I think I may consider the options available for hair-pieces. If I can get something completely undetectable that I can sleep and shower in, I'll be happy for now.

 

1 hour ago, Raphael84 said:

When designing the hairline, if the design is aesthetically pleasing is only one factor. Based on the photo and design that you have digitally edited, 3000 grafts would approximately restore your frontal third. Can your donor support further loss and provide a full restoration over subsequent surgeries as you age? This will depend on your donor density, follicular groupings and hair calibre, which also must have an influence on the most appropriate hairline design for you. No specific data is known and so all opinions currently are subjective
 

That's a really good point. Do you know if beard or other body hair would be viable substitutes as filler? I've noticed I have 3 different types/colors of hair on my body. My head is a medium thickness dark blonde with red undertones, my beard is thick and red, and my body hair (arms, legs) is a very thin lighter blonde-red. Do the follicles adapt to the location they are transplanted, or would there just be a mix of textures?

 

1 hour ago, Raphael84 said:

Whatever your decision may be, your choice in potential doctor must have your long term objectives as their priority, and plan any frontal restoration accordingly with a very specific and bespoke approach. You will lose more hair, and whilst there is no crystal ball regarding extent and rate of future loss, this must be taken into consideration and will be integral to your long term satisfaction. Whilst now your hairline is your priority, and quite rightly. You likely will not be satisfied in 10 years time with a great hairline but a larger balding crown. This is something that younger patients are often not able to relate to, and believe that as they hit their late 30´s, it really won't matter any more. In reality, that is rarely the case.

I really appreciate your insight on this. I really hope I'll find a doctor who will be on my team and help plan for the next decade or more. My ideal doctor is one who will be determined to give me the best results possible (and not just someone who sees me as 2% of the downpayment for their yacht). 

I've not considered the continued balding of my crown (even on fin/min). While I admittedly do fall into the category of younger patients who wrongfully "believe that as I hit my late 30´s, it really won't matter anymore", I would be interested in hearing what doctors have to say about the health and projected health of my donor areas and if I'd be a candidate for future surgeries as well.

 

Thank you again for everyone who responded. I will try my best to keep responding in this thread. 

[ITA]

1 hour ago, g4designs said:

and not just someone who sees me as 2% of the downpayment for their yacht). 

😂😂😂😂😂I had never heard this yet .... but it's true.😂😂😂😂

[Snowboard]

I get money matters but if you are in the US I think just save up another year or two before going to a top clinic.  You need maybe 3000 for a good result so the $12,000 just isn’t going to get you there unfortunately.  My advice would be save like crazy for a few years then get it done right with Konior or H&W.
 

You have to realize the serious risk that comes from a botched transplant.     It sucks but plenty of guys out there are bald, however a bad transplant really sticks out like a sore thumb.  Your donor looks good but if it gets torched in a bad procedure you could lose your ability to fix your hair.  

[Britanium]

Turkey does have some quality options. For example HLC, Pekiner, Keser and Bicer. As long as you consider these decent places and not the plethora of hair mills you would be fine. And as others have mentioned Europe has many excellent options too. Bisanga, HDC, Freitas, Couto just for example. Your budget would allow you to get a elite clinic for sure. 

[J5_95]

Your hair loss pattern and hair characteristics look quite similar to time pre-op, although yours is more strawberry to my blonde and your temple points are further eroded. Others have already given some excellent clinic options, but you're NW IV, in my opinion, and I believe it will take more than 3000 grafts to achieve the hairline and density you're looking for. Luckily you have what looks like a bomb donor so your options are pretty open, don't waste it.

As for the the yachts, there is no altruism in business, and these docs aren't doing this out of the kindness of their hearts, but I think all the top shops know that they are only as good as their last results. Nothing wrong with making lots of money for doing something you're good at 😉

[Melvin- Admin]

@Gatsby

Has some knowledge based on what he’s gone through in his own life. Being young and making a decision based off money is never a wise choice.

Now, are there good affordable clinics? Absolutely, but you need to research based on results and quality first and then weed clinics out based on budget. I’m not aware of the other two surgeons you mentioned, but Dr. Cooley is one of the best surgeons in the US. If he’s close to you, it’s a no-brainer. 
 

Check out his profile and look at some of the patient experiences/reviews. Those matter the most.

https://www.hairtransplantnetwork.com/physician/North-Carolina/Jerry-Cooley/4

 

[Melvin- Admin]

Also, I’d throw in Dr. Shapiro in Minnesota. Check out @hybonixthread, you guys have similar hair characteristics and hair loss.